New Psych Job

verene, MSN · Jan 30, 2018

New grad, new psych RN here. I work float-pool so it has been a very steep learning curve and my day varies based on where specifically I am working at. I work both sub-acute and residential facilities.

In general though:

Go in get report, and get organized for the day (write up my brain: make note of med times, who needs vitals/labs etc, who has appointments scheduled etc).

Quick round to check in with my team of staff, say hello to residents who are awake, introduce myself to those who are new, and check in with those I may be familiar with.

Start pulling and passing medications.

Check in with provider when they arrive.

Take care of tasks/administrative issues (e.g. following up on notes left from prior shifts, phone calls, reordering meds, setting appointments etc.)

Spend time checking in with residents, assessments and education.

Admits/Discharges and associated tasks

Team meeting

(Lunch)

Processing orders from provider.

Afternoon medication pass.

More time with residents.

Write progress notes.

Shift report for support staff.

Any administrative tasks that have yet to be finished.

Prepare to hand the floor over to on-coming nurse, shift report.

Not every day, every location has all of these things, and not always the same order even if they all happen. Plus there is always the potential of medical or psychiatric emergency which could throw the flow of the day. In general though I really enjoy the work and am fortunate to have great teams to work with at all of the locations I float to.

Big things for me are getting organized at the start of the day, and periodically forcing a few brief time-out on-myself to reorganize and prioritize if the day is getting really busy. Getting to know the teams I work with at each location is also a big help - knowing the people you work with, what you can count on them for, and their routines helps with organization and flow for the day. Many of the staff I work with have been working in this setting a long-time, even if they aren't RNs there is a lot I can learn from them.

Also getting to know the providers and how they like to work. One of the providers I work with is a no chit-chat individual, he's blunt and to the point and expects concise communication. With him I make a point of being extremely prepared and stick use SBAR to stay concise in any conversation. Another, really likes social chit-chat and even if I am concise in my concerns to her, we will probably still have some social dialog that has little to do with patient care, particularly at start of day. I enjoy working with both of these individuals as well as the other providers employed at this organization, but they are different, and letting all of the providers I work with know that I am new, but receptive to feedback and want work to work with them however works best for their flow has gone a long way towards me having good relationships with all of them. A couple of them have gone out of their way to mentor me and offer advice and support which has been really helpful.

I also keep a cheat sheet of each location with who to call, when to call, and where things are. Plus what documentation is important where (because it isn't the same in each location - e.g. some want daily progress notes, others want weekly). I also write down non-urgent questions that come up through out the day so I can check in with another RN when available.

I guess also; stay curious, anytime I don't know something or don't understand something or just want to learn more I look it up and try to educate myself.

Amethyst_RN · Jan 30, 2018

Thank you so much! That was very helpful. I will definitely stay curious. I love learning about psych and anything related. I always want to know more and appreciate any time I can talk with someone that has more experience and knowledge.

LisaNICUrn, BSN · Jan 31, 2018

So great to hear someone so excited about psych. Congratulations on your first nursing job. It was my first job as well. You definitely want a "brain" to keep yourself somewhat organized. The one thing for me that always got me off was PRN meds. Psych patients live and breathe by their PRN meds. The first thing I do is look at the last time they received them and if they can have them, I automatically pull them with the first med pass. If not, most of them will ask you for them and you'll spend the first 2 hours running back and forth just giving PRN meds. Just make sure you keep track of who's is who's so you can return if they don't want them. Anticipate their needs. It also gives you more time to spend talking to them instead of running around. You can do your mental assessment at that time. But definitely know how often they can have it and if it's not time, let them know when they can have it so they don't bug you ever 10 minutes. Once I learned that, everything else fell in to place.

GeminiNurse29 · Feb 3, 2018

I don't know what your setting is, but always be aware of safety and surroundings, especially the exit. Yes, not all people with mental health issues are dangerous or violent. But I'm talking from my background in forensic psych (so yes my patients all committed crimes) and geriatric psych. Don't take anything anyone says personally. And hopefully if you're inpatient, they will teach you de-escalation techniques and possibly physical intervention techniques.

Amethyst_RN · Feb 4, 2018

Thank you for the replies.

I will keep in mind the PRNs and make sure to stay as organized as possible. I always carry a notepad and write things down religiously.

I will be on an adult inpatient unit in a hospital. I know that during my orientation period I will have CPI training. I'm familiar with this because it was briefly covered during our mental health rotation in school, but I'm nervous about actually utilizing it with patients. I know confidence and feeling comfortable will come with experience. I think I'm just going to let everyone know that I really am interested in learning anything and everything I can. I'm hoping that will get me through the rough patches.

kingvonnBSN2017, BSN · Feb 6, 2018

Welcome to psych! I'm a new grad working on an adult inpatient unit as well. I love my job, it's amazing. During orientation, you'll learn a lot and learn tips from other nurses and you can pick and choose what suits you. That's helped me a lot. I was nervous about the take downs, the violent patients.. but honestly, it doesn't happen as much as I thought it would. The best part is that you won't be alone (keep a safe distance from patients, know your exits), take downs and dealing with violent patients takes a team effort. If you're unit is big on teamwork, you should be fine. Enjoy!